Functional and multi-omics signatures of mitapivat efficacy upon activation of pyruvate kinase in red blood cells from patients with sickle cell disease

Mitapivat, a pyruvate kinase (PK) activator, shows great potential as a sickle cell disease (SCD)- modifying therapy. Safety and efficacy of mitapivat as a long-term maintenance therapy is currently being evaluated in two open-label studies. Here we apply a comprehensive multi-omics approach to investigate the impact of activating PK on red blood cells (RBCs) from 15 SCD patients. HbSS patients were enrolled in one of the open label, extended studies (NCT04610866). Leuko-depleted RBCs obtained from fresh whole blood at baseline (visit 1, V1), prior to drug initiation and longitudinal time points over the course of the study were processed for multiomics through a stepwise extraction of metabolites, lipids and proteins. Mitapivat therapy had significant effects on the metabolome, lipidome and proteome of SCD RBCs. Mitapivat decreased 2,3-diphosphoglycerate (DPG) levels, increased adenosine triphosphate (ATP) levels, and improved hematologic and sickling parameters in patients with SCD. Agreement between omics measurements and clinical measurements confirmed the specificity of mitapivat on targeting late glycolysis, with glycolytic metabolites ranking as the top correlates to parameters of hemoglobin S (HbS) oxygen affinity (p50) and sickling kinetics (t50) during treatment. Mitapivat markedly reduced levels of proteins of mitochondrial origin within 2 weeks of initiation of drug treatment, with minimal changes in the reticulocyte counts. The first six months of treatment also witnessed transient elevation of lysophosphatidylcholines and oxylipins with depletion in free fatty acids, suggestive of an effect on membrane lipid remodeling. Multi-omics analysis of RBCs identified benefits for glycolysis, as well as activation of the Lands cycle.

The RN-BSN Bridge Course: Transitioning the Re-Entry Learner

BACKGROUND

Although most RN-to-BSN programs offer bridge courses, little can be found in the literature about common course objectives, content, or outcomes.

METHOD

This article details course objectives, course content, course implementation, and preliminary outcomes of a primarily distance learning RN-to-BSN bridge course at a northern California university.

RESULTS

Preliminary outcome assessments suggested greater than expected increases in role and campus socialization, as well as computer literacy, as a result of RN-to-BSN bridge course implementation.

CONCLUSION

The RN-to-BSN bridge course can successfully be used to transition the re-entry student and may be the link allowing RN-to-BSN students to effectively face the concurrent challenges of role socialization and computer literacy while mastering course content and course objectives.

Field-modulated selective ion storage in a quadrupole ion trap

A new method of selective ion storage in a quadrupole ion trap is described. Broadband waveforms were applied to the endcaps of an ion trap to eject unwanted ions by resonance excitation, which enhanced the storage of selected target ions. A unique trapping field amplitude modulation technique allowed the use of waveforms with fewer frequency components. The requirements and methods of calculations for frequency-optimized wave-forms are discussed. Advantages of this method include the reduction of target ion loss that results from collision-activated dissociation. In other applications, equivalent performance, relative to methods that use nonmodulated trapping fields combined with waveforms that have a higher frequency density, was shown.

Clinical significance of weight difference between donor and recipient in heart transplantation

A standard and important criterion for donor acceptance is to match the donor's body weight to within 20% of the recipient's body weight. However, to meet the increasing demand of patients who need heart transplantation, frequently a heart that is below the standard criteria for donation is accepted. Of the 200 consecutive patients who underwent heart transplantation at the University of Arizona, 27 patients received a heart from a smaller donor with a weight difference of more than 30% (range 30% to 46%). The early mortality and late survival of these 27 patients were not different when compared with those of the patients who received transplants from donors with a weight difference of less than 30%. The probability of freedom from rejection and infection and postoperative ejection fraction were also similar between the two groups. Therefore, we believe that the widely accepted donor-recipient weight-match criterion of 20% can be safely extended.

Mitral valve replacement six years after cardiac transplantation

A 33-year-old man found to have increasing mitral regurgitation and decreasing exercise tolerance 6 years after cardiac transplantation received a mitral bioprosthesis. For 8 months he has been without complications from the valve replacement and is clinically and hemodynamically considerably improved.